CERT Damage Assessment Form - KL7JFT



Community Emergency Response Team (CERT) Damage Assessment Form Date: Person Reporting: Page _____ of _____ Time Received: Person Receiving: Burning Burning Out Out Gas Lead Gas Lead H2O Lead H2O Lead Electric Electric Chemical Chemical Damage * Damage * Collapsed Collapsed Injured Injured Trapped Trapped Deceased Deceased Access Access No Access No Access Assignment Completed Assignment Completed Time Location/Address Fires Hazards Structures People Roads /X FOR USE BY CERTS & HAM TEAMSEVERYONE cert- 20 July 2009 Summary of all hazards in area - fill out this form on your way to Command Post and give it to Incident Command. (* for structure damage: H=HEAVY, M=MODERATE, L=LIGHT) Incident Command: Choose an incident, put a slash in the “assignment completed” column, copy the address/location to the incident name section on Incident Briefing, and give Incident Briefing and Assignment Status to incident team leader. Copy address/location to Post-Incident Status and enter start time. When incident is complete, put a backslash in the assignment completed column and the incident end time on the Post-Incident Status form. Last Updated: 7/20/2009 9:47:24 AM Revision: v1.1 Page 1 of 2DAMAGE ASSESSMENT FORM - Instructions This is the most-used form. Block Volunteers and CERT teams should use it to record incidents as they find them. The Planning Leader copies information to a master Damage Assessment Form (DA) for the neighborhood. Specific column instructions include: Top Line - Fill in the fields with your information & ID number. Incident Number - The Radio Operator will give you a number when you complete your call in - write it here. Time - The person recording may use military time (e.g. 1400 is 2 pm.) it is faster to write down. Do not include the time in your radio calls. Reported By - Block Volunteers put a check in this column when they radio the line to the Command Post (CP). The CP uses this column to enter the ID number of the caller. Incident Priority - 1 = Life threatening; 2 = Property/Fire; and 3 = all other. Location - Give the house address or intersection street names for the incident. Fire & Hazard columns - put a 1 in any column that applies. Building Damage Assessment - put a 1 in appropriate column. (See table below) People - Write a 1 or 0 in each column. When reporting the "People" section, do not report the types by radio because the victim's family may be listening. Report the 4 categories as digits only. Thus, a situation with no Immediates, 2 Delayed, no Trapped and 1 Dead would be called in as, "People, zero, two, zero, one." ? Road - put a 1 in Access for partially blocked roads; put a 1 in No Access for blocked roads. ? Other - Put a 1 here if the incident doesn't fit any other category. Assigned - If a team is assigned to one of your incidents, put a single slash here. When the team is finished, add a cross slash to form an "X" Comments - Use to describe the situation, but be brief. CERT Mission by Structural Damage Category If Structural Damage Is . . . Then The CERT Mission Is . . . Light: To locate, triage, and prioritize removal of victims to treatment areas by the medical operation teams. Moderate: To locate, stabilize, and immediately evacuate victims to a safe area while minimizing the number of rescuers inside the building. Heavy: To secure the building perimeter and warn others about the danger of entering the building. Light Moderate Heavy Broken windows. Decorative work damaged or fallen. Tilting / Obvious instability. Fallen or cracked plaster. Many visible cracks in plaster. Heavy smoke or fire. Minor damage to contents. Major damage to interior content. Gas leaks. Still attached to the foundation. Not attached to the foundation. Do not enter under any circumstances. Volunteers reporting in by radio should provide their information in the same left to right sequence as the columns on the form: For example: "Radio Control, this is #16 with a Priority 2." "This is Radio Control, go ahead # 16 with your priority 2." "This is #16 and my priority 2 is for One Six Zero Zero Begen (NOT sixteen hundred). Building, zero, one, zero; comments, chimney has fallen." . ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download